Page 175 - Cultural Competence in Health Education

Communication and Cultural Competence 153

but instead withheld treatment for the purpose of observing the natural etiology of the
disease progression in African Americans. The study came to a halt when the press
found out (CDC, 2005). However, the study should have never been conducted, because
it is purely unethical to treat people in this way. Although this was an atrocious situa-
tion, some good did come out of it. It led to the writing of the Belmont Report and the
creation of a national human investigation board (the National Commission for the Pro-
tection of Human Subjects of Biomedical and Behavioral Research) and of institutional
review boards, which all mandate ethical standards for experiments on human subjects
in the United States. Globally, the Nuremberg Code, which was established after the
World War II atrocities in Nazi Germany, created a set of rules for the protection of
human subjects in biomedical research (Annas & Grodin, 1995; Angell, 1989).

COMMUNICATING ACROSS CULTURES
ABOUT HEALTH AND DISEASE
Most cultures have culturally specific perceptions and conceptual explanations of health

and disease. Hence it is important to keep cultural sensitivities in mind in discussions
across cultures about health and disease. Examples of such conceptual explanations are
the demonic, celestial, phytogenic, and miasmic theories of disease causation. When
taboos and myths exist for certain populations, then it is important that health educators
be familiar with them in order to effectively provide health care services to these clients.
There are four factors to consider when communicating across cultures: (1) the
audience ’ s degree of health literacy; (2) the audience ’ s level of knowledge about health
and disease; (3) the audience ’ s attitudes toward health, disease, and prevention; and
(4) structural obstacles.
Health Literacy
The degree of literacy, especially health literacy (the ability to read and comprehend
health information), is important when communicating across cultures with brochures
and other written educational materials, because not everybody is at the same reading
level. It does not make sense to use brochures written at the high school level when the

majority of the population of interest has not finished high school. Such materi-
als would create frustration and confusion. It is crucial to provide educational materials
that are targeted toward the appropriate reading and comprehension level for each cul-
tural group. Also it is necessary to consider using different communication strategies
for different cultures.
Level of Knowledge
Level of knowledge regarding health and disease is an important factor to consider when
dealing with a diverse population. People from a small, rural community may be less
educated than those who live in a large, urban area; therefore health educators need to
communicate on the same level found among the audience for ease of comprehension.
This is imperative because these less knowledgeable people are the people who need

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